Severe anemia in Papua New Guinean children from a malaria-endemic area: a case-control etiologic study.
Severe anemia in Papua New Guinean children from a malaria-endemic area: a case-control etiologic study.
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DOI：
10.1371/journal.pntd.0001972
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发表时间：
2012
影响因子：
3.8
通讯作者：
Davis TM
中科院分区：
文献类型：
--
作者：
Manning L;Laman M;Rosanas-Urgell A;Michon P;Aipit S;Bona C;Siba P;Mueller I;Davis TM
很少有疟疾流行地区儿童严重贫血的详细病因学研究，在多种疟原虫全地方性传播的国家也没有。在一项病例对照横断面研究中，我们检查了143名特征明确的0.5-10岁巴布亚新几内亚（PNG）儿童中血红蛋白浓度<50 g/L（中位数[四分位数范围]39 g/L）和120名匹配的健康儿童（113 [107-119]g/L）的严重贫血相关因素。一系列社会人口统计学、行为学、人体测量学、临床和实验室（包括遗传）变量被纳入以严重贫血为因变量的多变量模型。与氯喹或阿莫地喹可能对细小病毒B19 （B19V）复制的营养作用一致，B19V PCR/IgM阳性的比值比最高（95%可信区间）为75.8(15.4-526)，其次是恶性疟原虫感染（19.4(6.7-62.6)），维生素a缺乏症（13.5(5.4-37.7)），年龄体重指数z-score <2.0（8.4(2.7-27.0)）和不完全疫苗接种（2.94(1.3-7.2)）。间日疟原虫感染呈负相关（0.12(0.02-0.47)），反映了早期获得免疫和/或缺乏应对寄生虫入侵的网织红细胞。在输入缺失数据后，缺铁是一个微弱的阳性预测因子（占人口归因风险的6.4%）。这些数据表明，巴布亚新几内亚儿童的严重贫血是多因素的，与营养不足和某些常见感染密切相关，并且有可能通过补充维生素A和改善营养、完成疫苗接种计划以及使用非氯喹/阿莫地喹为基础的间歇性预防性抗疟疾治疗方案来预防。严重贫血与发病率和死亡率增加有关，在发展中国家相对常见。为了确定世界上感染（特别是疟疾）、营养不良和遗传易感普遍的地区严重贫血的原因，我们研究了巴布亚新几内亚因严重贫血住院的儿童和健康的非贫血社区对照。与严重贫血相关的因素有细小病毒B19感染、恶性疟疾、维生素A缺乏、年龄体重指数低和疫苗接种不完全。间日疟疾呈负相关，反映了早期获得免疫力或可能缺乏循环红细胞以应对寄生虫入侵。缺铁只是一个微弱的阳性预测因子。这些数据表明，巴布亚新几内亚儿童的严重贫血是多因素的，与营养不足和某些感染密切相关，并有可能通过补充维生素A和改善营养、完成疫苗接种计划以及预防或积极治疗疟疾来预防。
There are few detailed etiologic studies of severe anemia in children from malaria-endemic areas and none in those countries with holoendemic transmission of multiple Plasmodium species. We examined associates of severe anemia in 143 well-characterized Papua New Guinean (PNG) children aged 0.5–10 years with hemoglobin concentration <50 g/L (median [inter-quartile range] 39 g/L) and 120 matched healthy children (113 [107–119] g/L) in a case-control cross-sectional study. A range of socio-demographic, behavioural, anthropometric, clinical and laboratory (including genetic) variables were incorporated in multivariate models with severe anemia as dependent variable. Consistent with a likely trophic effect of chloroquine or amodiaquine on parvovirus B19 (B19V) replication, B19V PCR/IgM positivity had the highest odds ratio (95% confidence interval) of 75.8 (15.4–526), followed by P. falciparum infection (19.4 (6.7–62.6)), vitamin A deficiency (13.5 (5.4–37.7)), body mass index-for-age z-score <2.0 (8.4 (2.7–27.0)) and incomplete vaccination (2.94 (1.3–7.2)). P. vivax infection was inversely associated (0.12 (0.02–0.47), reflecting early acquisition of immunity and/or a lack of reticulocytes for parasite invasion. After imputation of missing data, iron deficiency was a weak positive predictor (6.4% of population attributable risk). These data show that severe anemia is multifactorial in PNG children, strongly associated with under-nutrition and certain common infections, and potentially preventable through vitamin A supplementation and improved nutrition, completion of vaccination schedules, and intermittent preventive antimalarial treatment using non-chloroquine/amodiaquine-based regimens. Severe anemia is associated with increased morbidity and mortality, and it is relatively common in developing countries. To establish the causes of severe anemia in a part of the world in which infection (especially malaria), malnutrition and genetic predisposition are prevalent, we studied children from Papua New Guinea who were hospitalized with severe anemia and healthy non-anemic community-based controls. Factors associated with severe anemia were parvovirus B19 infection, falciparum malaria, vitamin A deficiency, low body mass index for age and incomplete vaccination. Vivax malaria was inversely associated reflecting early acquisition of immunity or perhaps lack of circulating red blood cells for parasite invasion. Iron deficiency was only a weak positive predictor. These data show that severe anemia is multifactorial in Papua New Guinean children, strongly associated with under-nutrition and certain infections, and potentially preventable through vitamin A supplementation and improved nutrition, completion of vaccination schedules, and prevention or active treatment of malaria.
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DOI：
10.1182/asheducation-2009.1.87
发表时间：
2009
期刊：
Hematology. American Society of Hematology. Education Program
影响因子：
--
作者：
Haldar K;Mohandas N
通讯作者：
Mohandas N
影响因子：
158.5
作者：
Calis, Job C. J.;Phiri, Kamija S.;van Hensbroek, Michael Boele
通讯作者：
van Hensbroek, Michael Boele
影响因子：
3.3
作者：
CATTANI, JA;TULLOCH, JL;CLANCY, R
通讯作者：
CLANCY, R
影响因子：
3.2
作者：
Fishman, Steven M.;Christian, Parul;West, Keith P., Jr.
通讯作者：
West, Keith P., Jr.
影响因子：
4.2
作者：
Brabin, BJ;Premji, Z;Verhoeff, F
通讯作者：
Verhoeff, F